Organization
BOOMER 06, PLLC
Active
Other names
The Mobile Therapy Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN EDWARD ELASSAL (PHYSICAL THERAPIST)
(405) 996-0660
Entity
Organization
Contact information
Practice address
10921 S WESTERN AVE STE 200, OKLAHOMA CITY, OK 73170-6228
(405) 996-0660
Mailing address
10921 S WESTERN AVE STE 200, OKLAHOMA CITY, OK 73170-6228
(405) 676-5606
(405) 676-5374
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200934220A
—
OK
Enumeration date
02/13/2020
Last updated
10/22/2024
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